Metro Detroit Area Research Articles

Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan

BackgroundMaintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare’s impact on participants’ ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers.MethodsWe used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.ResultsIn the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.ConclusionHomecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.

The impact of covid-19 vaccination on intrauterine fetal demise rates among pregnant women in the Metro-Detroit area

The impact of covid-19 vaccination on intrauterine fetal demise rates among pregnant women in the Metro-Detroit area

Comparison of anaphylaxis epidemiology between urban and suburban pediatric emergency departments

BackgroundAnaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. To date, there are no published data on epidemiology of pediatric anaphylaxis in Michigan. Our objective was to describe and compare the time trends in incidence of anaphylaxis in urban and suburban populations of Metro Detroit.MethodsWe performed a retrospective study of Pediatric Emergency Department (ED) anaphylaxis visits from January 1, 2010, to December 1, 2017. The study was conducted at 1 suburban ED (SED) and 1 urban ED (UED). We identified cases using an International Classification of Diseases (ICD) 9 and 10 query of the electronic medical record. Patients were included if they aged 0–17 years and met the 2006 National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network diagnostic criteria for anaphylaxis. The anaphylaxis rate was calculated as the number of detected cases divided by the total number of pediatric emergency room visits for that month. Anaphylaxis rates were compared between the two EDs using Poisson regression.ResultsA total of 8,627 patient encounters had ICD codes for anaphylaxis, of which 703 visits fulfilled the inclusion criteria and were used in subsequent analyses. Overall, the incidence of anaphylaxis was more common in males and in children < 4 years of age in both centers. Although the total number of anaphylaxis related visits was higher at UED over the eight-year time frame for this study, the anaphylaxis rate (cases per 100,000 ED visits) throughout the study was higher at the SED. While the observed anaphylaxis rate at UED was 10.47 – 162.05 cases per 100,000 ED visits, the observed anaphylaxis rate at SED was 0 – 556.24 cases per 100,000 ED visits.ConclusionPediatric anaphylaxis rates differ significantly between urban and suburban populations in metro Detroit EDs. The rate of anaphylaxis related visits to the ED has significantly increased over the past 8 years in the metro Detroit area, with significantly higher rise in suburban compared to urban ED. More studies are needed to explore the reasons for this observed difference in increase rates.

Abstract HUP16: Disparities In Stroke Care In The Metro Detroit Area

Introduction: According to the AHA, approximately 795,000 people suffer a stroke per year. Studies have also shown that people with a lower socioeconomic status (SES) have a higher mortality rate at 1 year following a stroke. Rehabilitation is fundamental to stroke recovery but requires adequate access to health care and support systems. Patient with lower socioeconomic status may not have adequate access to health care or the support systems leading to delays in transfer to rehabilitation centers, longer hospital stays, increased complication rates, and poorer outcomes. Hypothesis: Patients with lower SES have longer hospital stays and are more likely to be discharged home rather than to inpatient rehabilitation centers. Methods: Retrospective observational cohort study of 744 patients discharged from Neurology units with primary diagnosis of acute ischemic stroke. Patients were grouped by zip code into bottom 50 median household income (lower SES) and top 50 median household income (higher SES). Income data was obtained from the United States Census Bureau. Results: Fewer patients with lower SES were discharged by hospital day 5 compared to those with higher SES (58% vs. 68%). Additionally, more patients with lower SES were discharged home rather than to a rehabilitation center after hospital day 5 (15% vs. 7%). Conclusion: Those from communities with lower SES had longer hospital stays and were less likely to be discharged to rehabilitation centers after longer hospital stays. Longer hospital stays suggests those with lower SES encounter obstacles that prevent and even preclude transfer to rehabilitation centers. Larger studies should be performed to identify and ameliorate factors that limit access to proper post-stroke care such as adequate rehabilitation.

The impact of COVID-19 vaccinations on stillbirth rates among pregnant women in the Metro-Detroit area

Infection by COVID-19 increases maternal morbidity and mortality prompting both the American College of Obstetrics and Gynecology and the Society of Maternal Fetal Medicine to strongly recommend vaccination during pregnancy. Limited data exist assessing the risk of intrauterine fetal death (IUFD) associated with COVID vaccination during pregnancy.This was a retrospective chart review at a large multisite hospital system in Metro Detroit which reviewed data from 13,368 pregnancies. We compared IUFD rates between vaccinated and unvaccinated patients. The rate of stillbirths among unvaccinated women (0.75%) was not statistically different from those who were vaccinated (0.60%). Individuals with government insurance were less likely to be vaccinated and more likely to have IUFD in comparison to patients with private insurance. The rate of stillbirths among Black women was significantly higher than among White women at a rate of 1.1% compared to 0.53% (p=0.008) with no difference in stillbirth rates among vaccinated vs unvaccinated racial distribution. Lastly, it is worth noting that the overall vaccination rate at our healthcare system in pregnancy was very poor (0.26%).In conclusion, this is a large population of highly diverse patients which indicates that COVID-19 vaccination does not lead to IUFD. We plan to use this data to help drive an educational vaccination campaign to try to increase our COVID-19 vaccination rate in our pregnant patients. Systemic racism and social determinants of health have played a large factor in COVID-19 outcomes, and our data highlights that this is the case for IUFD in Black women. Improvements must be made to identify barriers for these women to allow for better pregnancy outcomes. We acknowledge that individuals with government insurance may also have other barriers to healthcare or face healthcare inequity which leaves room for improvement on getting these individuals vaccinated and getting the resources they need to have better pregnancy outcomes.

Assessing Equity in Public Beach Access with Spatial Intersectionality

Previous research on beach access typically uses socioeconomic variables such as race or ethnicity and different levels of wealth to identify marginalized groups. Such an additive approach, however, fails to consider the intercategorical intersectionality between variables when defining marginalized groups. Moreover, there is little research that assesses the spatial variability of intersectional groups in relation to public beach access. This study addressed these gaps by empirically examining the spatially heterogeneous intercategorical intersectionality of race or ethnicity and poverty in terms of public beach access. A geographically weighted regression was employed via a case study of 784 census tracts in the Metro Detroit area. The results showed that economically marginalized White neighborhoods, overall, had greater access to public beaches than economically marginalized African American and Asian neighborhoods had. Furthermore, there exists spatially heterogeneous (in)equitable access to public beaches depending on the type of intersectional composition of the neighborhood. These findings are useful for beach managers to allocate resources to neighborhoods in need of more access to public beaches.

Investigation of pollutant metals in road dust in a post-industrial city: Case study from Detroit, Michigan

Inhalation and/or ingestion of toxic heavy metals enriched in road dust have toxic effects on humans. From inhalation and ingestion of dust, release of readily bioavailable elements sorbed on to dust, could lead to health issues such as lung or skin cancer, kidney dysfunction, hypertension, dermal lesions, peripheral neuropathy, and vascular disease. On 49 road dust and soil samples collected in the Metro Detroit area, we analyzed a suite of trace metals in &amp;lt;63 μm and size-separated fractions to quantify the extent of metal enrichment and contamination status. We evaluated Enrichment Factor (EF), Pollution Index (PI), Geoaccumulation Index (GI), and Pollution Load Index (PLI). The average Chromium (Cr) concentration of 198 ppm is the highest reported for any global city in literature while in ∼80% samples, Barium (Ba), Cr, Lead (Pb), and Zinc (Zn) concentrations exceeded the USEPA limit. The EF for Barium (Ba) was found to be ≥9 in all samples, and for the rest of other elements was &amp;gt;1.5. The PI values for Cr, Ba, Zinc (Zn), Lead (Pb), and Selenium (Se) indicate elevated levels and for Ba, Cr, and Zn up to a moderate level. PLI values in &amp;gt;50% of road dusts were ≥3, indicating many sites are ‘heavily polluted’. The PLI value in Detroit road dust is higher than those reported for some other global cities including Shanghai. Observed strong correlations between Cr-Zn and Cadmium (Cd)-Silver (Ag) likely indicate a common metal source. Cluster analysis of data for Cd, Arsenic (As), Pb, and Zn appears to be distinct between different proximally related clusters, while Nickel (Ni) and Ba are potentially more distinct between property type clusters. In general, metal concentrations of industrial samples are more commonly distinct with over half of metals (≥6 of 11) differing from residential and/or soil samples. Three generalized “groups” were identified from the combination of hierarchical cluster and PCA analyses followed by varimax rotation: Group 1 characterized by Cr, Cd, Ni, Ag, Zn, and Copper (Cu); Group 2 characterized by Pb, As, Mercury (Hg), and minor Ba; and Group 3 characterized by Se. This is the first study to report all four metrics of metal pollution along with rigorous statistical analysis.

Influenza vaccination uptake during COVID-19 pandemic: A trusted messenger approach

Objective: Seasonal influenza is a preventable disease that may cause high morbidity and mortality. In the USA, the 2020 influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. There is a dearth of research on understanding influenza vaccination uptake and attitudes towards the vaccine among marginalised communities in the USA. The aim of this study was to examine general knowledge, misconceptions about, and barriers to influenza vaccination and determine if flu education delivered via trusted messengers improved knowledge among Asian Americans. Design: Quantitative prospective pre- and post-test design. Setting: Asian American communities in Metro Detroit area, Hamtramck, and Kent County in Michigan. Method: The study started with a training event in which 26 community leaders were trained to become trusted messengers to disseminate flu education. A total of 260 Asian American participants subsequently completed pre- and post-education surveys. Results: Asian Americans in the study reported low flu vaccination rate (48.5%). Reasons varied but included access-related issues (e.g. no access and no insurance) and health literacy (did not know they needed it). After education by trusted messengers, the paired t tests measuring improvement between pre- and post-survey scores showed a significant improvement ( p &lt; .05) for all of the knowledge items. Conclusion: Educational campaigns using targeted messages to address specific barriers and acknowledge individuals’ concerns regarding misconceptions while providing equitable vaccine access can be key for the successful implementation of vaccination programmes.

The Original and Short Versions of the Activities-Specific Balance Confidence (ABC) Scale in Community-Dwelling Older Adults: Clinical Implications Based on Scale Agreement, Internal Consistencies, and Associations With Self-Rated Health.

Balance confidence assessment in older adults has implications for falls prevention and quality of life. It remains unclear whether the original Activities-specific Balance Confidence Scale (ABC-16) or the shortened 6-item scale (ABC-6) is recommended clinically. This study examined ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) in community-dwelling older adults. Secondary analysis of an existing dataset (N = 77) was performed. Scale association and agreement were assessed with a Spearman ρ correlation (rs), intraclass correlation coefficient, 95% limits of agreement (LoA), and Bland-Altman plot. Cronbach α values were calculated to determine internal consistencies. Separate multiple linear regression models with SRH as the outcome and ABC-6 and ABC-16 scores as primary predictors were estimated and subsequently used to conduct Hotelling t test. Participants were primarily female (80.5%) with a median age of 68 years living in the metro Detroit area. The ABC-6 and ABC-16 were closely associated [rs = 0.97, P < .001; intraclass correlation coefficient (2,1) = 0.80] but demonstrated discrepancy (95% LoA range of -3.9 to +18.2; mean difference = 7.2 points in the direction of the ABC-16). Cronbach α values were 0.95 (ABC-16) and 0.89 (ABC-6). Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2 = 0.36) in SRH compared with model 2 (ABC-16 = primary predictor; R2 = 0.29). Hotelling t test [t(74) = 2.4, P = .008] found that the predicted values from the ABC-6 model were significantly more highly correlated with SRH than those from the ABC-16 model. Despite a high correlation between the ABC-16 and ABC-6, the 2 scales showed limited agreement and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 may be preferable to the ABC-16 for balance confidence assessment in older adults living in cold weather, urban, or well-resourced areas.

What Predictors Reduce Quality of Life in Head and Neck Cancer Patients?

IntroductionHead and neck cancers (HNCA) encompasses about 4% of all cancers in the U.S. However, the disease has a disproportionate impact on patients’ quality of life (QOL). Surgical and medical therapies can result in deformities of the head and neck, leading to severe impairment in speech, swallowing, and psychosocial problems. There is a primary focus on disease-specific treatment and survival, but QOL is a treatment outcome that has been increasingly recognized as an important outcome parameter in HNCA. ObjectivePostoperative QOL may be overlooked when managing head and neck cancer patients. The purpose of this study is to identify patient and surgical factors influencing QOL of head and neck cancer patients in hopes to improve patient outcomes. Materials and methodsThe authors implemented a retrospective cohort study design and enrolled a sample composed of head and neck cancer patients treated between 2017 and 2018. The predictor variables were grouped into the following categories: risk factors (smoking, alcohol, past medical history), demographic (sex, age, marital status), anatomic (tumor location, tumor stage), perioperative (utilization of a feeding tube, tracheostomy, neck dissection) and postoperative factors (chemotherapy or radiation therapy utilization). The primary outcome variable was the Head and Neck Quality of Life (HNQOL) score with higher scores correlated with poorer QOL. Descriptive statistics were completed for all the variables. Association between the predictor variables and HNQOL scores were examined using bivariate statistics and statistical significance was set at P < .05. ResultsThe study sample composed of 78 patients presenting or referred to the Center of Head and Neck Maxillofacial and Reconstructive Surgery Clinic at Ascension Macomb-Oakland from January 1, 2017, to August 31, 2018. Surgeries were completed at Ascension Macomb-Oakland and Ascension St. John Hospitals by 1 primary surgeon in the metro Detroit area. Of the 78 patients meeting inclusion, 31 patients completed the validated University of Michigan HNQOL instrument. The sample's mean age was 66 (±1.7) and 71% were male. The median HNCA QOL score was 18 with a maximum score of 80. Variables associated with poorer QOL scores were: radiation therapy (21 vs. 5.5, P = .033), perioperative feeding tube (31 vs. 9, P = .012), utilization of chemotherapy (12.5 vs 9.0, P = .60), male gender (17 vs 9.5, P = .39), perioperative tracheostomy (26 vs. 14.5, P = .26), current/prior tobacco use (19.5 vs. 11.5, P = .81), single marital status (27 vs. 16, P = .48), neck dissection (17.5 vs. 15.5, P = .91), and alcohol use (18.5 vs. 16.0, P = .65). ConclusionThe study results suggest that the presence of a feeding tube and utilization of radiotherapy most significantly decreased QOL among HNCA. Additional factors associated with poorer QOL were radiation therapy, utilization of a feeding tube, chemotherapy, male sex, tracheostomy utilization, tobacco use, single/divorced marital status, neck dissection, and alcohol abuse.

Pregnant Black Women and Emergency Department Utilization: Assessing Self-Reported Receipt of Prenatal Counseling.

There is limited literature on emergency department (ED) use among pregnant women. In this article, we examined the associations between prenatal counseling with the use of the ED during pregnancy. In our cohort of Black women in the Metro Detroit area, we found that approximately 70.5% of the women had an ED visit at some point during pregnancy. In unadjusted models of prevalence ratios, we found women reporting receipt of prenatal counseling regarding fetal movement, what to do about baby's movement slowing down, and smoking (but not what to do about smoking) were at statistically significantly greater risk of ED utilization during pregnancy. Adjustment for confounders slightly weakened the associations for counseling about baby's movement or smoking, so that the associations were no longer statistically significant. These findings call for further research on ED utilization among this population, especially differentiating urgent versus non-urgent use of the ED during pregnancy.

Dietary and Lifestyle Behaviors of Bangladeshi-Americans in Southeast Michigan

Abstract Objectives South Asians, including Bangladeshis have a high incidence of chronic disease. The Metro-Detroit area has one of the largest populations of Bangladeshi-Americans in the USA. There is insufficient research on their dietary habits and lifestyle which are important determinants of health. The objective of this research was to investigate the dietary and lifestyle behaviors of Bangladeshi-Americans in Michigan, and compare them with the recommended dietary guidelines. Methods A culturally appropriate cross sectional survey with 25 questions was created and completed by residents (n = 49, 18 + years) of Bangladeshi descent living in Michigan. Quantitative and qualitative data regarding socioeconomic status, diet, physical activity, sleep and health were gathered. Data were analyzed using excel. Fruit and vegetable intakes were compared to the Dietary Guidelines for Americans recommendations. Results The majority (69%) of survey respondents were women. Only 36% of the participants consumed fruits daily; 62% of participants consumed vegetables every day. Rice was a daily staple consumed by 75% of respondents. Thirty seven % of participants reported that they were overweight while 66% were trying to lose weight. Barely 37% of participants exercised for 30 minutes or more daily. Only 16% reported getting the required 8 hours of sleep daily. Cardiovascular disease, hyperlipidemia, hypertension and diabetes were commonly present and 53% reported taking medication daily. Conclusions Most participants did not meet Dietary Guidelines recommendations for fruit and vegetable consumption or for physical activity. Further research into culturally appropriate lifestyle interventions and health education strategies to reduce the burden of disease in this vulnerable population is needed. Funding Sources NA.

Comparison of Out-of-Hospital Cardiac Arrests and Fatalities in the Metro Detroit Area During the COVID-19 Pandemic With Previous-Year Events

Stig Nikolaj Blomberg, MsC; Helle Collatz Christensen, MD, PhD; Freddy Lippert, MD; Annette Kjær Ersbøll, MsC, PhD; Christian Torp-Petersen, MD, PhD; Michael R. Sayre, MD; Peter J. Kudenchuk, MD; Fredrik Folke, MD, PhD

606. HIV Homecare: Understanding its Impact for Lost-to-Follow-Up Populations

BackgroundMaintaining people living with HIV (PLWH) in clinical care is a global priority. In the metro-Detroit area of Michigan, approximately 30% of PLWH are out of care. To re-engage lost-to-follow-up patients, the Wayne State University Physician Group – Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. In the first year of Homecare, 28 of 34 participants became virally suppressed at least once. We aimed to understand reasons why people who left clinic-based treatment were able to become virally suppressed in this program. We included data from PLWH and their healthcare workers.MethodsWe used a mixed-methods design, including (1) semi-structured interviews with PLWH and healthcare workers, and (2) a validated Likert scale questionnaire rating illness perception before and after Homecare. Data were collected from 15 PLWH in metro-Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a grounded theory approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the brief illness perception questionnaire (BIPQ) were compared using paired T-tests.ResultsThe Homecare program offered (1) social support and stigma reduction through strong relationships with healthcare workers; (2) removal of physical and resource barriers such as transportation; and (3) positive changes in illness perceptions. PLWH worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. BIPQ showed significant changes in six domains before and after Homecare.Homecare Conceptual Framework General Joint Display: Brief Illness Perception Questionnaire ConclusionHomecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWH in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.Disclosures All Authors: No reported disclosures

Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic

CONTEXTFor many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. The purpose of this study was to examine how well a sample of patients (N = 177) in three Michigan-based primary care teaching clinics thought they and their loved ones were prepared in terms of having their EOLC wishes known.METHODSProspective data were collected from three Internal Medicine teaching clinics in the Metro-Detroit area through an anonymous written survey addressing EOLC issues in a 16-item cross-sectional study. Respondents were adult patients at one of three participating primary care clinics. Perceived preparedness for EOLC was measured by: 1) possibly having had a prior EOLC discussion with a healthcare provider 2) having created an Advance Directive, such as a Durable Power of Attorney (DPOA) or Living Will with medical decision preferences, 3) reported preferences for quality versus quantity of life, and 4) preferences for CPR and other specific life-sustaining interventions.RESULTSIn this sample, 77 (43.5%) of 177 respondents had discussed their EOLC wishes with a provider. Regarding Advance Directives, 63/177 (35.6%) had established a DPOA, and 59/177 (22%) had made a Living Will. The majority of respondents preferred quality over quantity of life. The most difficult EOLC questions included the decision for CPR, tracheostomy, and PEG tube placement.CONCLUSIONSBased on these results, EOLC discussions probably occur infrequently in the primary care or other healthcare settings. Most survey responses indicated that sample patients were unprepared concerning the details of future EOLC decisions. Engagement of such discussions should be a part of routine visits in the primary care clinic and should be re-visited when there is a change in a patient’s health. Further larger-scale studies using validated surveys are required in this vitally important area of practice. Key Words: advance care planning, end-of-life care conversations, primary care

The Utility of EMRs in Student Run Clinics.

A student-run free clinic (SRFC) is a health care delivery system in which undergraduate medical students assume the responsibility of an outpatient health clinic. This provides a unique opportunity for early exposure to patients in a student's pre-clinical years. Pre- and post-experience electronic surveys were sent out to first-year medical students who were required to complete a minimum of three sessions as a volunteer at one of two SRFCs in the metro Detroit area. The Fisher's exact test was used to assess for a significant change after clinic experience with p<0.05. Thirty-one students completed the pre-experience survey. Twenty-five students completed the post-experience survey. The Fisher's exact test demonstrated a significant increase in the proportion of positive answers for questions concerning comfort with taking a medical history (p=0.002) and comfort with using an electronic medical record (EMR) (p=0.048). There was no significant difference in comfort working as part of a team (p=0.581), discussing a patient with a physician (p=0.602) or interacting with different socio-economic backgrounds (p=0.720). SRFCs provide a beneficial opportunity for early patient and clinical exposure for pre-clinical medical students, including practice using an EMR, which is an essential tool in our electronic era. More research, however, is needed to determine the most effective way to teach skillful EMR use.

Epidemiology of Diabetic Foot Infection in the Metro-Detroit Area With a Focus on Independent Predictors for Pathogens Resistant to Recommended Empiric Antimicrobial Therapy.

BackgroundThe polymicrobial nature of diabetic foot infection (DFI) and the emergence of antimicrobial resistance have complicated DFI treatment. Current treatment guidelines for deep DFI recommend coverage of methicillin-resistant Staphylococcus aureus (MRSA) and susceptible Enterobacteriaceae. This study aimed to describe the epidemiology of DFI and to identify predictors for DFI associated with multidrug-resistant organisms (MDROs) and pathogens resistant to recommended treatment (PRRT).MethodsAdult patients admitted to Detroit Medical Center from January 2012 to December 2015 with DFI and positive cultures were included. Demographics, comorbidities, microbiological history, sepsis severity, and antimicrobial use within 3 months before DFI were obtained retrospectively. DFI-PRRT was defined as a DFI associated with a pathogen resistant to both vancomycin and ceftriaxone. DFI-MDRO pathogens included MRSA in addition to PRRT.ResultsSix-hundred forty-eight unique patients were included, with a mean age of 58.4 ± 13.7 years. DFI-MDRO accounted for 364 (56%) of the cohort, and 194 (30%) patients had DFI-PRRT. Independent predictors for DFI-PRRT included history of PRRT in a diabetic foot ulcer, antimicrobial exposure in the prior 90 days, peripheral vascular disease, and chronic kidney disease. Long-term care facility residence was independently associated with DFI due to ceftriaxone-resistant Enterobacteriaceae, and recent hospitalization was an independent predictor of DFI due to vancomycin-resistant Enterococcus.ConclusionsAn unexpectedly high prevalence of DFI-PRRT pathogens was identified. History of the same pathogen in a prior diabetic foot ulcer and recent antimicrobial exposure were independent predictors of DFI-PRRT and should be considered when selecting empiric DFI therapy.

Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers.

Objectives To explore African American women’s breastfeeding thoughts, attitudes, and experiences with healthcare professionals and subsequent influences on their breastfeeding interest and behavior. Insight was also sought about the most effective practices to provide breastfeeding support to African American women. Methods Thirty-eight pregnant or lactating African American women and racially diverse health professionals were recruited and participated in one of six membership specific focus groups in the metro Detroit area. An experienced focus group facilitator who was African American woman served as the primary group facilitator, using a semi-structured guide to discussions. Focus groups explored perceptions of personal and professional roles and behaviors that support African American women’s breastfeeding behavior. Discussions were digitally recorded and audiotapes were transcribed. Thematic content analysis was conducted in combination with a review of field notes. Results Participants generally agreed that breastfeeding is the healthier feeding method but perceived that healthcare providers were not always fully supportive and sometimes discouraged breastfeeding. Non-breastfeeding mothers often expressed distrust of the information and recommendations given by healthcare providers and relied more on peers and relatives. Health professionals lacked information and skills to successfully engage African American women around breastfeeding. Conclusions for Practice Breastfeeding initiation and duration among African American mothers may increase when postpartum breastfeeding interventions address social and cultural challenges and when hospital breastfeeding support with the right professional lactation support, is void of unconscious bias and bridges hospital, community, peers, and family support. Professional lactation training for healthcare professionals who are in contact with expectant and new mothers and an increase in the number of IBCLC of color could help.

Substance Abuse amongst Middle Eastern Community in Metro Detroit, Michigan, USA

Background: Substance abuse is a global endemic costing billions. Its impact on healthcare is unparalleled, hence assessing risk factors and prevalence is necessary. The study objective was to review substance abuse amongst Middle Eastern community in Metro Detroit, Michigan US. Methods: A random sample (n=337) of Iraqi (Arab vs. Chaldean) who were residents in metro Detroit area were studied. The substance abuses studied were alcohol, amphetamine, sedative and street drugs. Chi-square test, Binary logistic regression and linear regression analysis were used. Results: Study results concluded that there was significant difference in the prevalence of substance abuse in the two groups, with Chaldeans having higher ‘all substance abuse’ prevalence. On further analysis, Chaldeans had a higher prevalence in alcohol (51%), whereas Arabs had more street drug use (9.8%) (p<0.001). Being a male, Chaldean, and having depression are a risk factor predictor for combined substance abuse. Depression was the common risk factor predictor for all combined substance, sedative and street drug use. Risk factor predictors for excellent health were among Chaldean, young, and those who do not report symptoms of depression. Employed and those who have stayed in the USA for a long time. Amongst the users, Arabs had a higher prevalence of hypertension, headache, amnesia, muscles or tendons conditions, and depression (p<0.005). Conclusion: There was significant difference between Arab and Chaldean in prevalence of substance abuse. Chaldeans had more alcohol usage, whereas Arabs had more street drug use. Individuals with depression and of Chaldean ethnicity have a high risk factor for combined substance–especially alcohol.

Optimizing water delivery system storage and its influence on air pollutant emission reduction

This paper presents a quantitative approach to estimating the carbon dioxide (CO2) emission reduction by optimizing water storage operations in water delivery systems. This approach uses hydraulic models of water delivery systems to perform pumping energy optimization analyses with equalization water storage and identifies marginal electrical generation types based on locational marginal price (LMP) data available in open electrical markets. The marginal pollutant emission reduction has been evaluated based on pumping energy optimization, hourly marginal generation types and pollutant emission rates for different types of generation. An example is presented that applied the proposed approach to a large water delivery system in the Metro Detroit area, Michigan. The analysis results showed a daily CO2 emission reduction of 11.7tonnes, which accounted for approximately 3% of the total CO2 emission produced by the electricity consumption for pumping water under the maximum day demand condition of 2012.